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Nicole Larson, PhD, MPH, RD: University of Minnesota (UMN)

What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts. Nicole Larson, PhD, MPH, RD: University of Minnesota (UMN) Dianne Ward, EdD: University of North Carolina Sara Benjamin Neelon, PhD, MPH, RD: Duke University

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Nicole Larson, PhD, MPH, RD: University of Minnesota (UMN)

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  1. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Nicole Larson, PhD, MPH, RD: University of Minnesota (UMN) Dianne Ward, EdD: University of North Carolina Sara Benjamin Neelon, PhD, MPH, RD: Duke University Mary Story, PhD, RD: UMN JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  2. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Purpose Serum Vitamin C (mg/dl) by Salad Intake • Review studies of relevance to U.S. preschool children (2-5 years) enrolled in center-based care or family child-care homes that have addressed: • state regulations relating to nutrition and physical activity • child care practices and policies with the potential to influence dietary intake and physical activity • the perceptions and practices of preschoolers’ parents with implications for obesity prevention • Review interventions conducted in the U.S. and internationally that were designed to prevent obesity in child-care settings through the promotion of better nutrition, increased physical activity, or reduced time spent in sedentary activities JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  3. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Methods Serum Vitamin C (mg/dl) by Salad Intake • Conducted electronic literature search of two databases: PubMed and MEDLINE • Key words: child care, preschool, nursery school, dietary intake, physical activity, sedentary activity, intervention, obesity, overweight • Manual search of bibliographies included in identified studies • Included studies published between January 2000 and July 2010 • Included intervention studies only if an evaluation of program impact or feasibility was completed JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  4. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Results: State Regulations Serum Vitamin C (mg/dl) by Salad Intake • Four recent reviews of state regulations found that most states lacked strong regulations related to healthy eating and physical activity (1-4). • Child-care centers tended to be the most heavily regulated and have more specific regulations, followed by large family and group child-care homes (2). • Small family child-care homes tended to have the fewest and most general regulations (2). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  5. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Results: Practices & Policies of Relevance to Healthy Eating Serum Vitamin C (mg/dl) by Salad Intake • 2 nationally-representative studies (5,6) and 4 smaller studies (7-10) have evaluated the nutritional quality of foods provided to preschool-aged children • 7 studies (5,9,11-15) have assessed mealtime behaviors of child-care providers and education/training • Results have identified opportunities for better promoting healthy eating relating to the provision of 1% or skim milk, fruits, and vegetables; training providers to help children pay attention to their internal signals of hunger and satiation; and providing nutrition education for children JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  6. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Results: Practices, Policies, and Environmental Factors of Relevance to Physical Activity Serum Vitamin C (mg/dl) by Salad Intake • Children rarely achieve 60 minutes of moderate-to-vigorous physical activity during the child-care day (16, 17). • Children’s physical activity levels vary considerably (up to 47%) depending upon the child-care facility they attend (18, 19-21). • Factors that may account for this variation in physical activity include: • The amount of time allocated for active play, time spent outside, and indoors activities (20, 22) • More space per child on the playground (23) • Having more trees, shrubbery, and open play areas (24) • Access to more portable equipment (e.g., balls) (20, 23, 25) • Teacher prompts (26) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  7. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Results: Perceptions & Practices of Parents Serum Vitamin C (mg/dl) by Salad Intake • Evidence suggests that many parents do not recognize a preschool-aged child is obese and a considerable proportion of parents of normal-weight children perceive their child to be underweight (27-29). • Only 2 studies examining parent perceptions and behaviors relevant to the nutrition and physical activity environment in child-care settings were identified (30-31). • Common recommendations from parents for promoting healthy eating and physical activity in center-based care settings include (30): • Serving more fruits and vegetables • Offering a greater variety of foods • Providing more structured and caregiver-led activities • Providing additional outdoor time JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  8. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Results: Obesity Prevention Interventions Serum Vitamin C (mg/dl) by Salad Intake • 18 interventions were identified: • 4 focused on nutrition outcomes • 7 focused on physical activity or sedentary activity outcomes • 7 addressed a combination of nutrition and activity outcomes • Only 5 of the 18 interventions targeted environmental factors such as improvements in foodservice practices and playground environments. • An assessment of impact on child weight status was completed for just 5 interventions, and only 2 studies (32, 33) showed some evidence of success in reducing risk for obesity. • The 2 interventions found to have an impact on child weight status included multiple components to address nutrition, physical activity, and sedentary behaviors. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  9. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Implications for Future Research Serum Vitamin C (mg/dl) by Salad Intake • Studies evaluating the impact of state regulations are needed to ensure that desired improvements are realized and there are no unintended consequences. • There is a particular need for nationally-representative studies designed to identify influences on healthy eating and physical activity in family child-care homes. • Additional research is needed regarding parental behaviors and perceptions to better inform the design of future interventions. • There is a need to evaluate multi-component obesity prevention programs that address both nutrition and physical activity behaviors. • Research is needed to develop valid and reliable measures of policies and other environmental outcomes in child-care settings. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  10. References What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Serum Vitamin C (mg/dl) by Salad Intake Benjamin S. Obesity prevention in child care: a review of U.S. state regulations. BMC Public Health. 2008;8:188. http://www.biomedcentral.com/1471-2458/8/188. Accessed May 2010. Kaphingst K, Story M. Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States. Prev Chronic Dis. 2009;6(1):A11. http://www.cdc.gov/pcd/issues/2009/jan/07_0240.htm. Accessed December 28, 2009. Cradock A, O’Donnell E, Benjamin S, Walker E, Slining M. A review of state regulations to promote physical activity and safety on playgrounds in child care centers and family child care homes. J Phys Act Health. 2010;7:S108-S119. Benjamin S, Copeland K, Cradock A, Neelon B, Walker E, Slining M, Gillman M. Menus in child care: a comparison of state regulations with national standards. J Am Diet Assoc. 2009;109:109-115. Whitaker R, Gooze R, Hughes C, Finkelstein D. A national survey of obesity prevention practices in Head Start. Arch PediatrAdolesc Med. 2009;163:1144-1150. Crepinsek M, Burstein N, Lee E, Kennedy S, Hamilton W, Abt Associates Inc. Meals offered by tier 2 CACFP family child care providers - Effects of lower meal reimbursements. Washington D.C.: United States Department of Agriculture, Economic Research Service; 2002 March. Ball S, Benjamin S, Ward D. Dietary intakes in North Carolina child-care centers: are children meeting current recommendations? J Am Diet Assoc. 2008;108:718-721. Wu Y, Hertzler A, Miller S. Vitamin A, vitamin C, calcium and iron content of federally funded preschool lunches in Virginia. J Am Diet Assoc. 2001;101:348-351. Trost S, Messner L, Fitzgerald K, Roths B. Nutrition and physical activity policies and practices in family child care homes. Am J Prev Med. 2009;37:537-540. Padget A, Briley M. Dietary intakes at child-care centers in central Texas fail to meet Food Guide Pyramid Recommendations. J Am Diet Assoc. 2005;105:790-793. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  11. References What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts Serum Vitamin C (mg/dl) by Salad Intake Gooze R, Hughes C, Finkelstein D, Whitaker R. Reaching staff, parents, and community partners to prevent childhood obesity in Head Start, 2008. Prev Chronic Dis. 2010;7:3. http://www.cdc.gov/pcd/issues/2010/May/09_0115.htm. Accessed July 31, 2010. Sigman-Grant M, Christiansen E, Branen L, Fletcher J, Johnson S. About feeding children: mealtimes in child-care centers in four Western states. J Am Diet Assoc. 2008;108:340-346. Gable S, Lutz S. Nutrition socialization experiences of children in the Head Start program. J Am Diet Assoc. 2001;101:572-577. Ramsay S, Branen L, Fletcher J, Price E, Johnson S, Sigman-Grant M. "Are you done?" Child care providers' verbal communication at mealtimes that reinforce or hinder children's internal cues of hunger and satiation. J Nutr Educ Behav. 2010;42:265-270. Freedman M, Alvarez K. Early childhood feeding: assessing knowledge, attitude, and practices of multi-ethnic child-care providers. J Am Diet Assoc. 2010;110:447-451. Reilly J, Kelly L, Montgomery C, Williamson A, Fisher A, McColl J, Lo Conte R, Paton J, Grant S. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ. 2006;333:1041. Cardon G, De Bourdeaudhuij IMM. Are preschool children active enough? Objectively measured physical activity levels. Res Q Exerc Sport. 2008;79:326-332. Pate R, McIver K, Dowda M, Brown W, Addy C. Directly observed physical activity levels in preschool children. J Sch Health. 2008;78:438-444. Pate R, Pfeiffer K, Trost S, Ziegler P, Dowda M. Physical activity among children attending preschools. Pediatrics. 2004;114:1258-1263. Bower J, Hales D, Tate D, Rubin D, Benjamin S, Ward D. The childcare environment and children's physical activity. Am J Prev Med. 2008;34:23-29. Finn K, Johannsen N, Specker B. Factors associated with physical activity in preschool children. J Pediatr. 2002;140:81-85. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  12. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts References Serum Vitamin C (mg/dl) by Salad Intake Dowda M, Pate R, Trot S, Joao M, Almeida C, Sirard J. Influences of preschool policies and practices on children's physical activity. J Community Health. 2004;29:183-196. Cardon G, Van Cauwenberghe E, Labarque V, Haerens L, De Bourdeaudhuij I. The contribution of preschool playground factors in explaining children's physical activity during recess. Int J Behav Nutr Phys Act. 2008;5:11. http://www.ijbnpa.org/content/5/1/11. Accessed August 14, 2010. Boldermann C, Blennow M, H HD, Mårtensson F, Raustorp A, Yuen L, Wester U. Impact of preschool environment upon children’s physical activity and sun exposure. Prev Med. 2006;42:301-308. Dowda M, Brown W, McIver K, Pfeiffer K, O'Neill J, Addy C, Pate R. Policies and characteristics of the preschool environment and physical activity of young children. Pediatrics. 2009;123:e261-266. Brown W, Googe H, McIver K, Rathel J. Effects of teacher-encouraged physical activity on preschool playgrounds. Journal of Early Intervention. 2009;31:126-145. Harnack L, Lytle L, Himes J, Story M, Taylor G, Bishop D. Low awareness of overweight status among parents of preschool-aged children, Minnesota, 2004-2005. Prev Chronic Dis. 2009;6(2). http://www.cdc.gov/pcd/issues/2009/apr/08_0043.htm. Accessed July 10, 2010. Baughcum A, Chamberlin L, Deeks C, Powers S, Whitaker R. Maternal perceptions of overweight preschool children. Pediatrics. 2000;106:1380-1386. Nelson J, Carpenter K, Chiasson M. Diet, activity, and overweight among preschool-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prev Chronic Dis. 2006;3(2):A49. http://www.cdc.gov/pcd/issues/2006/apr/05_0135.htm. Accessed July 18, 2010. Benjamin S, Haines J, Ball S, Ward D. Improving nutrition and physical activity in child care: what parents recommend. J Am Diet Assoc. 2008;108:1907-1911. Sweitzer S, Briley M, Robert-Gray C. Do sack lunches provided by parents meet the nutritional needs of young children who attend child care? J Am Diet Assoc. 2009;109:141-144. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

  13. What Role can Child-care Settings Play in Obesity Prevention? A Review of the Evidence and Call for Research Efforts References Serum Vitamin C (mg/dl) by Salad Intake Fitzgibbon M, Stolley M, Van Horn L, K KauferChristoffel, Dyer A. Two-year follow-up results for Hip-Hop to Health Jr.: A randomized controlled trial for overweight prevention in preschool minority children. J Pediatr. 2005;146:618-625. Eliakim A, Nemet D, Balakirski Y, Epstein Y. The effects of nutritional-physical activity school-based intervention on fatness and fitness in preschool children. J Pediatr Endocrinol Metab. 2007;20:711-718. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Larson N et al. J Am Diet Assoc. 2011; 111 (September).

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